| NPI | 1780635250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 02798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 02798) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-06-11 |